Giant Congenital Dacryocystocele Presenting with Globe Displacement: A Rare Cause of Orbital Mass Effect in an Infant

Abstract

Introduction: Congenital dacryocystocele is an uncommon form of lacrimal drainage obstruction in neonates. To the best of our knowledge, globe displacement secondary to a giant congenital dacryocystocele has not been previously reported. We describe a case of a giant congenital dacryocystocele complicated by acute dacryocystitis that produced significant orbital mass effect with globe displacement.

Case report: A 19-day-old female neonate presented with a bluish swelling over the right medial canthal region that had been present since birth. The lesion progressively enlarged and became complicated by acute dacryocystitis.
Intravenous antibiotic therapy improved the inflammation; however, the mass remained enlarged and displaced the globe superotemporally. Computed tomography demonstrated a 17.7 x 14.6 x 16.0 mm cystic lesion at the right medial canthus that was continuous with the nasolacrimal duct and exerted significant mass effect on the globe. Following resolution of the acute infection, nasolacrimal duct probing was performed, resulting in immediate decompression of the dacryocystocele and restoration of the globe to its normal position.

Conclusions: Giant congenital dacryocystoceles can present as a rare cause of orbital mass effect, resulting in globe displacement. Early recognition and timely intervention are essential to prevent serious complications associated with infection and airway obstruction.